Global health insurer The Cigna Group delivered solid revenue and earnings growth in 2025, broadly in line with peers across the US managed care sector, with its performance again underscoring the growing divergence between diversified health services groups and insurers more heavily exposed to medical cost inflation and government programs.
Cigna reported total revenues of $274.9bn for 2025, up 11% year on year, driven primarily by Evernorth Health Services. The revenue growth rate places Cigna toward the upper end of the sector: UnitedHealth Group reported high single-digit revenue growth for the year, while CVS Health’s top-line expansion was more modest as its Aetna unit faced elevated medical costs. Elevance Health also reported mid-single-digit growth, reflecting a more payer-centric mix.
Adjusted fourth-quarter revenues rose 10% year over year to $72.5bn, again tracking closely with peers that have leaned into pharmacy benefit management, specialty pharmacy and services-led growth rather than pure membership expansion.
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Cigna’s shareholders’ net income for 2025 rose to $6.0bn, or $22.18 per share, compared with $3.4bn in 2024, when results were distorted by a one-time non-cash investment loss. Adjusted income from operations increased to $8.0bn, or $29.84 per share, from $7.7bn in 2024.
That earnings profile contrasts with CVS Health and Elevance, both of which faced margin pressure during 2025 from higher-than-expected utilization, particularly in Medicare Advantage and outpatient services. UnitedHealth also reported earnings growth, but with more volatility across the year as it absorbed rising care delivery costs within OptumHealth.
In the fourth quarter, Cigna reported net income of $1.2bn, or $4.64 per share, compared with $1.4bn a year earlier, while adjusted income from operations rose to $2.1bn, or $8.08 per share. The adjusted improvement mirrors a broader industry trend: insurers with diversified services platforms generally delivered stronger adjusted earnings momentum than those more reliant on underwriting margins alone.
“In 2025, we expanded access and support, lowered costs, and improved transparency for our customers and patients,” chairman and CEO David Cordani said, positioning Cigna’s results as evidence that scale and diversification continue to matter as utilization trends normalize post-pandemic.
As with UnitedHealth’s Optum division, Evernorth was the main engine of growth in 2025. Cigna pointed to strong specialty pharmacy performance, pharmacy benefit services and behavioral health, areas that also drove growth at CVS Health’s Caremark unit and at UnitedHealth’s OptumRx and OptumInsight businesses.
Cigna reported that total customer relationships rose 3% year over year to 188.4 million, with pharmacy customers increasing 4% to 123.6 million and behavioral health customers jumping 18% to 28.3 million, supported by a new government contract. By contrast, peers reported slower growth in behavioral health, reflecting intensifying competition for employer and government contracts.
Medical membership declined 5% to 18.1 million, largely due to the previously announced HCSC transaction. Excluding that deal, Cigna said membership would have been broadly flat year on year. This compares with more pronounced membership volatility at some rivals, particularly in Medicare Advantage, where several insurers either exited unprofitable markets or repriced aggressively during 2025.
Cigna said medical cost trends during 2025 were broadly in line with expectations, despite ongoing pressure from outpatient care, behavioral health utilization and specialty drugs. This stands in contrast to peers such as CVS Health and Elevance, which both flagged higher-than-expected utilization as a drag on margins during parts of the year.
Based on its performance, Cigna issued a 2026 medical care ratio guidance range of 83.7%–84.7% for Cigna Healthcare, broadly consistent with sector averages but signaling confidence in cost control relative to some competitors that have guided to narrower or higher ranges.
Operating efficiency was another area of relative strength. Cigna’s SG&A expense ratio fell to 5.3% for full-year 2025, down from 6.0% in 2024, reflecting tighter cost discipline than several peers still investing heavily in systems, integration and care delivery assets.
Cigna ended 2025 with a debt-to-capitalization ratio of 43.0%, slightly improved from the prior year and broadly comparable with UnitedHealth and Elevance. During the year, the group repurchased $3.6bn of shares and increased its quarterly dividend to $1.56 per share, a move in line with peers that continue to prioritize capital returns despite regulatory uncertainty.
CVS Health, by comparison, was more cautious on buybacks as it focused on balance sheet flexibility, while UnitedHealth maintained a more aggressive capital return profile supported by its scale and cash generation.
For 2026, Cigna guided to approximately $280bn in adjusted revenues and at least $7.95bn in consolidated adjusted income from operations, or $30.25 per share. Evernorth is expected to generate at least $6.9bn in pre-tax adjusted income, with Cigna Healthcare contributing a minimum of $4.5bn.
The outlook reflects an industry facing converging challenges: scrutiny of PBM practices, drug pricing reform, reimbursement pressure and persistently elevated utilization. Like UnitedHealth and CVS, Cigna said it continues to monitor regulatory developments closely, particularly around pharmacy benefit management and government programs, areas that are increasingly shaping competitive positioning across the sector.
Overall, Cigna’s 2025 performance places it firmly among the stronger performers in US health insurance, with its services-heavy model providing insulation from some of the cost volatility that continues to challenge more payer-centric peers.
